D:\Docstoc\Working\pdf\b4e8912e-b877-4549-bf8b-09066200a419.doc Alternative Summer Break ’09 Application Applications due: Friday, March 27, 2009 – 5pm Name: _________________________________________ Phone: ________________________________________ E-mail: _________________________________________ Do you prefer email or phone? ____________________ The mission of the Alternative Break program at Colorado State University is to create active citizens that think about and seek solutions to societal problems and continue to contribute to their respective communities as a lifelong process. The Alternative Break program is an immersion experience into different cultural, environmental and socioeconomic communities across the nation. Students provide service in exchange for education about current social and cultural issues facing the host communities. Note: This application is specifically for the Alternative Summer Break trips that will take place in May and August of 2009. ADD DATES Malibu, California August 8, 2009-August 16, 2009 Florida City, Florida May 25, 2009- May 31, 2009 Fairbanks, Alaska May 17, 2009 –May 28, 2009 Boulder Creek, California May 31, 2009 – June 6, 2009 On a separate sheet, please type or print your answers to the following questions. (One page limit). 1. Please rank your top trip choice and address why you have chosen to rank the trips in that order. Would you be willing to participate in a trip that is not your first choice? Please explain. Trip choices include: Boulder Creek, California: YMCA Camp Campbell Outdoor Science School; Youth Fairbanks, Alaska: Alaskan Bird Observatory/Calypso Farm and Ecology Center/Chena Renewable Geothermal Energy Plant; Environment Florida City, Florida; Biscayne National Park; Wildlife Conversation Malibu, California; Camp Heartland; Youth with HIV/AIDS What do you see as your role as an individual living in a diverse society? What is the value of individual differences? How might this experience enhance your academic, personal and career goals? What role do you play in a group? How will you contribute to your group’s Alternative Break experience? Describe past efforts you have made to become a more active and involved member of a community. How did you hear about Alternative Break? Please describe all previous AB trips or similar experiences, and what you have gained from your participation. If new to AB, please describe what you hope to gain from this experience. 2. 3. 4. 5. 6. D:\Docstoc\Working\pdf\b4e8912e-b877-4549-bf8b-09066200a419.doc FEES AND PAYMENTS The costs of your trip will be paid in two ways: 1) Deposits made to the Office for Student Leadership, Involvement, and Community Engagement (SLICE Office). Deposits made to the SLICE Office will cover the costs of food, lodging, rental cars, and public transportation. Deposits made to SLICE should be cash or checks made out to “CSU.” The SLICE Office does not accept credit cards. 2) Airline tickets purchased on your own. You are responsible for purchasing your own airline ticket and turning in a copy of your itinerary to the SLICE Office no later than Monday, April 20, 2009. The one exception to this is the Boulder Creek, California trip. Your program fee to SLICE for that trip is included in the total cost. TRIP NAME DEPOSIT to SLICE OFFICE DUE MONDAY, APRIL 20, 2009 Fairbanks, AK Boulder Creek, CA Florida City, FL Malibu, CA $725 $325 $250 $275 Approximate cost of airline ticket (to be purchased on your own) $950 N/A (flight cost included in amount due to SLICE) $300 $250 TOTAL COST OF TRIP $1675 $325 $550 $575 Please initial next to each of the following statements to acknowledge your understanding. _____ By initialing here, I agree to the above payment schedule. ______ Payments made to CSU/SLICE are NONREFUNDABLE. I agree to pay nonrefundable deposit on Monday, April 20, 2009. Deposits should be made in cash or checks made out to “CSU.” We do not take credit cards. _____ Airline tickets are not purchased by the SLICE Office. I understand that I am responsible for purchasing my own airline ticket and turning in a copy of my itinerary to the SLICE Office no later than Monday, April 20, 2009. FUNDRAISING OPPORTUNITIES AVAILABLE! _____ All money raised during fundraising efforts will go DIRECTLY to the trip participant and NOT through SLICE or CSU. Trip participants are responsible for managing their own fundraising activities and efforts. The SLICE office can serve as a fundraising resource, however fundraisers for AB trips are individual and group initiatives. Fundraisers are not formally sponsored CSU or SLICE events. Please initial next to each of the following statements to acknowledge your understanding. INSURANCE INFORMATION _____ For your safety, we ask that all participants be covered by health insurance or purchase a temporary insurance plan. By initialing here I confirm that I have health insurance coverage or intend to purchase temporary insurance. Policy information will be collected prior to trip departure and kept on file for emergencies. If you need help finding health insurance, please contact the SLICE office for more information. D:\Docstoc\Working\pdf\b4e8912e-b877-4549-bf8b-09066200a419.doc PRE- AND POST-TRIP MEETINGS Attendance at ALL of the following meetings/events is mandatory. Please initial each date below to confirm that you have read and understood the meeting times. If you are unable to attend one of the times listed, please indicate below. Pre- and Post-trip Meeting Schedule Alaska ____Wednesday April 15, 2009 7:15-8:15pm, Room 227LSC ____ Thursday April 23, 2009 7:15-8:15pm, Room 211E LSC ____ Thursday April 30, 2009 7:15-8:15pm, Room 211E LSC ____ Thursday May 9, 2009 7:15-8:15pm, Room 211E LSC ____Alternative Summer Break! May 17, 2009 – Thursday May 28, 2009 _____ Wrap up meetings TBD Florida ____Thursday April 16, 2009 6-7pm, Room TBD ____Thursday April 23, 2009 6-7pm, Room TBD ____Wednesday April 29, 2009 6-7pm, Room 211E LSC ____Wednesday May 6, 2009 6-7pm, Room 211E LSC ____Alternative Summer Break! May 25, 2009-May 31, 2009 _____ Wrap up meetings TBD Malibu, CA ____Tuesday April 14, 2009 7-8pm, Room 234 LSC ____ Tuesday April 21, 2009 7-8pm, Room 217 LSC ____ Tuesday April 28, 2009 7-8pm, Room 217 LSC ____ Tuesday May 5, 2009 7-8pm, Room 217 LSC ____Alternative Summer Break! August 8, 2009-August 16, 2009 _____ Wrap up meetings TBD Boulder Creek, CA ____Monday April 13, 2009 7-8pm, Room 232 LSC ____ Monday April 20, 2009 7-8pm, Room 232 LSC ____Monday April 27, 2009 7-8pm, Rom 232 LSC ____Monday May 4, 2009 7-8pm, Room 232 LSC ____Alternative Summer Break! May 31, 2009-June 6, 2009 _____ Wrap up meetings TBD Thank you for taking the time to fill out an application. You will be notified of your application status no later than April 6, 2009. Applicants invited to interview will be contacted directly by the Site Leaders. Please direct all general questions to Kate Quillin (email@example.com ; 970-491-3922) or stop by the SLICE Office located on the main level of the Lory Student Center, behind the main information desk. I have read and agree to the above information: Applicant Signature: _________________________________________________________ Parent/Guardian Signature (required if under the age of 18): ________________________________ Date: ____________ Date: ____________ Please return to: Student Leadership, Involvement & Community Engagement – Main Level, Lory Student Center – 491-1682 Priority application deadline is Friday, March 27, 2009 – 5:00pm.